PUBLIC LAW 108–173—DEC. 8, 2003
117 STAT. 2109
of ‘15 percent’ instead of coinsurance of ‘25 percent’ in section 1860D–2(b)(2). ‘‘(E) REDUCTION OF COST-SHARING ABOVE ANNUAL OUTOF-POCKET THRESHOLD.—Subject to subsection (c), the substitution for the cost-sharing imposed under section 1860D–2(b)(4)(A) of a copayment or coinsurance not to exceed the copayment or coinsurance amount specified under section 1860D–2(b)(4)(A)(i)(I) for the drug and year involved. ‘‘(3) DETERMINATION OF ELIGIBILITY.— ‘‘(A) SUBSIDY ELIGIBLE INDIVIDUAL DEFINED.—For purposes of this part, subject to subparagraph (F), the term ‘subsidy eligible individual’ means a part D eligible individual who— ‘‘(i) is enrolled in a prescription drug plan or MA– PD plan; ‘‘(ii) has income below 150 percent of the poverty line applicable to a family of the size involved; and ‘‘(iii) meets the resources requirement described in subparagraph (D) or (E). ‘‘(B) DETERMINATIONS.— ‘‘(i) IN GENERAL.—The determination of whether a part D eligible individual residing in a State is a subsidy eligible individual and whether the individual is described in paragraph (1) shall be determined under the State plan under title XIX for the State under section 1935(a) or by the Commissioner of Social Security. There are authorized to be appropriated to the Social Security Administration such sums as may be necessary for the determination of eligibility under this subparagraph. ‘‘(ii) EFFECTIVE PERIOD.—Determinations under this subparagraph shall be effective beginning with the month in which the individual applies for a determination that the individual is a subsidy eligible individual and shall remain in effect for a period specified by the Secretary, but not to exceed 1 year. ‘‘(iii) REDETERMINATIONS AND APPEALS THROUGH and appeals, with MEDICAID.—Redeterminations respect to eligibility determinations under clause (i) made under a State plan under title XIX, shall be made in accordance with the frequency of, and manner in which, redeterminations and appeals of eligibility are made under such plan for purposes of medical assistance under such title. ‘‘(iv) REDETERMINATIONS AND APPEALS THROUGH COMMISSIONER.—With respect to eligibility determinations under clause (i) made by the Commissioner of Social Security— ‘‘(I) redeterminations shall be made at such time or times as may be provided by the Commissioner; and ‘‘(II) the Commissioner shall establish procedures for appeals of such determinations that are similar to the procedures described in the third sentence of section 1631(c)(1)(A).
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